Use of a comprehensive frailty assessment to predict morbidity in patients with multiple myeloma undergoing transplant

Rosko, Ashley; Huang, Ying; Benson, Don M.; Efebera, Yvonne A.; Hofmeister, Craig C.; Jaglowski, Samantha; Devine, Steven M.; Bhatt, Geetika; Wildes, Tanya M.; Dyko, Alanna; Jones, Desirée; Naughton, Michelle J.; Byrd, John C.; Burd, Christin E.

doi:10.1016/j.jgo.2018.05.015

Cited by 78 publications

(54 citation statements)

References 46 publications

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“…Furthermore, many older adults are frail and have functional, psychological, and social vulnerabilities that may affect how information is communicated and processed. These age‐related vulnerabilities are associated with higher morbidity and mortality and add complexities to the care of and treatment decisions among older adults with cancer. Older adults are at a higher risk of experiencing adverse events related to cancer treatments ; therefore, ensuring older adults have similar beliefs about curability as their oncologists may allow them to receive goal‐concordant care.…”

Section: Introductionmentioning

confidence: 99%

Beliefs About Advanced Cancer Curability in Older Patients, Their Caregivers, and Oncologists

et al. 2019

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Background Ensuring older patients with advanced cancer and their oncologists have similar beliefs about curability is important. We investigated discordance in beliefs about curability in patient‐oncologist and caregiver‐oncologist dyads. Materials and Methods We used baseline data from a cluster randomized trial assessing whether geriatric assessment improves communication and quality of life in older patients with advanced cancer and their caregivers. Patients were aged ≥70 years with incurable cancer from community oncology practices. Patients, caregivers, and oncologists were asked: “What do you believe are the chances the cancer will go away and never come back with treatment?” Options were 100%, >50%, 50/50, <50%, and 0% (5‐point scale). Discordance in beliefs about curability was defined as any difference in scale scores (≥3 points were severe). We used multivariate logistic regressions to describe correlates of discordance. Results Discordance was present in 60% (15% severe) of the 336 patient‐oncologist dyads and 52% (16% severe) of the 245 caregiver‐oncologist dyads. Discordance was less common in patient‐oncologist dyads when oncologists practiced longer (adjusted odds ratio [AOR] 0.90, 95% confidence interval [CI] 0.84–0.97) and more common in non‐Hispanic white patients (AOR 5.77, CI 1.90–17.50) and when patients had lung (AOR 1.95, CI 1.29–2.94) or gastrointestinal (AOR 1.55, CI 1.09–2.21) compared with breast cancer. Severe discordance was more common when patients were non‐Hispanic white, had lower income, and had impaired social support. Caregiver‐oncologist discordance was more common when caregivers were non‐Hispanic white (AOR 3.32, CI 1.01–10.94) and reported lower physical health (AOR 0.88, CI 0.78–1.00). Severe discordance was more common when caregivers had lower income and lower anxiety level. Conclusion Discordance in beliefs about curability is common, occasionally severe, and correlated with patient, caregiver, and oncologist characteristics. Implications for Practice Ensuring older patients with advanced cancer and their caregivers have similar beliefs about curability as the oncologist is important. This study investigated discordance in beliefs about curability in patient‐oncologist (PO) and caregiver‐oncologist (CO) dyads. It found that discordance was present in 60% (15% severe) of PO dyads and 52% (16% severe) of CO dyads, raising serious questions about the process by which patients consent to treatment. This study supports the need for interventions targeted at the oncologist, patient, caregiver, and societal levels to improve the delivery of prognostic information and patients’/caregivers’ understanding and acceptance of prognosis.

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Section: Introductionmentioning

confidence: 99%

Beliefs About Advanced Cancer Curability in Older Patients, Their Caregivers, and Oncologists

et al. 2019

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“…Optimizing age-related deficits prior to autologous HCT is important to minimize morbidity and mortality among older adults and maximize quality of life following HCT. Impairment in pre-transplant physical function is associated with longer HCT-CI (p = 0.02) − Age (HR 1.084, p = 0.0011) − HCT-CI (HR 1.129, p = 0.048) − ADL change a (HR 0.989, p = 0.011) − IADL change a (HR 0.83, p b 0.0001) − Nutrition (HR 0.865, p = 0.0063) − Nutrition status change (HR 0.894, p = 0.0007) − Age b (HR 1.08, p = 0.002) − KPS b (HR 0.97, p = 0.02) − TUG (HR 3.26, 95% CI 1.001-10.6, p = 0.049) − Fatigue (HR 1.09, p = 0.039) − ADL change a (HR 0.986, p = 0.0021) − IADL change a (HR 0.849, p = 0.0014) − KPS change (HR 0.961, p b 0.0001) − Nutrition (HR 0.878, p = 0.0198) − Age (≥ 60; p = 0.0005) − IADL (p = 0.0003) − HCT-CI (p = 0.03) Not reported − Age (≥60; p = 0.0007) − IADL b (p b 0.0001) − HCT-CI (p = 0.03) − Mental health b (p = 0.01) − Walk speed b (p = 0.009) hospitalization, and weight loss pre-transplant correlates with higher relapse and death post-transplant in an age unrestricted study of adults with multiple myeloma [72]. This study also found a number of geriatric domains to be predictive of re-admissions: mental health, physical function, nutrition.…”

Section: Autologous Hctmentioning

confidence: 99%

“…Although of considerable interest, only limited data exists to date on GA after HCT. In patients age ≥18, GA three months after autologous HCT uncovered less fatigue but worse physical function [72]. Deschler et al performed GA in patients age ≥60 at one, three, and six months after allogeneic HCT [64].…”

Section: Post-hctmentioning

confidence: 99%

“…The BMT CTN 1704 study will provide more information to fill this gap. At minimum, tools should include physical function measures to complement comorbidity, as impaired function has consistently been shown in age-unrestricted (age ≥18) and in older adult patients (age ≥50 and age ≥60) to be predictive of worse survival after autologous and allogeneic HCT [62][63][64]72,88,89,91,96]. Based on this observation, combining IADLs with HCT-CI was evaluated in older recipients of allogeneic HCT and showed an increased predictive value for OS [62].…”

Section: Current Applicationmentioning

confidence: 99%

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Use of geriatric assessment in hematopoietic cell transplant

Jayani

Rosko

Olin

et al. 2020

Journal of Geriatric Oncology

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“…For example, low physical pre-transplant function and weight loss are associated with longer transplant hospitalizations. 25 The CARE clinic assesses older adult transplant candidates as well as younger patients for whom the referring provider has specific concerns. The CARE clinic uses a standardized GA, Rockwood's clinical frailty scale, 26 and the 1-year overall Center for International Blood and Marrow Transplant Research survival calculator 27,28 The CARE clinic's primary goal in evaluating transplant candidates is to identify deficits and mitigate risk factors to improve tolerability of the transplant.…”

Section: Hematologic Malignanciesmentioning

confidence: 99%

Implementing a Multidisciplinary Approach for Older Adults with Cancer: Geriatric Oncology in Practice

Presley

Krok‐Schoen

Wall

et al. 2020

Preprint

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Background: Evidence-based practice in geriatric oncology is growing, and national initiatives have focused on expanding cancer care and research to improve health outcomes for older adults.However, there are still gaps between knowledge and practice for older adults with cancer.Methods: Here we provide a detailed methodology of geriatric oncology care delivery within a single institution. The Cancer and Aging Resiliency (CARE) clinic is a multidisciplinary approach for implementing geriatric-driven health care for older adults with cancer. The CARE clinic was developed as a direct response to recommendations targeting key multifactorial geriatric health conditions (e.g. falls, nutritional deficits, sensory loss, cognitive impairment, frailty, multiple chronic conditions, and functional status). The multidisciplinary team assesses and delivers a comprehensive set of recommendations, all in one clinic visit, to minimize burden on the patient and the caregiver. The CARE clinic consultative model is a novel approach integrating cancer subspecialties with geriatric oncology healthcare delivery. Conclusions:Older adults with cancer have unique needs that are independent of routine oncology care. The CARE clinic model provides specific assessments and interventions to improve health outcomes among older adults with cancer. BackgroundOlder adults constitute the fastest growing demographic in the U.S. population and are the majority of patients with cancer. By 2030, 70% of all individuals diagnosed with cancer will be above the age of 65 years. However standard hematology/oncology clinical practices are not well adapted to address the unique needs of older adults with cancer. 1 Aging is associated with changes in physiologic function that are important to consider in treatment decisions for older adults with cancer. For example, with age, renal function can decline, 2 while the prevalence of anemia is increased. 3 Both of these are risk factors for chemotherapy-related toxicity in patients with cancer. Multiple chronic conditions and polypharmacy can also result in higher levels of treatment toxicity and reduced survival for older adults with cancer. 4 Multifactorial geriatric health conditions such as cognitive impairment, falls, and frailty can also impact patient outcomes but are not routinely assessed or Dr.

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Use of a comprehensive frailty assessment to predict morbidity in patients with multiple myeloma undergoing transplant

Abstract: Our data illustrate that a GA can identify individuals with MM who are at greater risk for morbidity following ASCT.

Cited by 78 publications

References 46 publications

Beliefs About Advanced Cancer Curability in Older Patients, Their Caregivers, and Oncologists

Beliefs About Advanced Cancer Curability in Older Patients, Their Caregivers, and Oncologists

Use of geriatric assessment in hematopoietic cell transplant

Implementing a Multidisciplinary Approach for Older Adults with Cancer: Geriatric Oncology in Practice

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